Project Summary The rural-urban divide is vast, with rural places tending to have poorer public health, lower levels of education, higher unemployment and lower wages and income, as just a few examples. This project is the first to systematically develop an understanding of conditions and change in small rural communities across the U.S. We identify patterns of change based on how social, economic, demographic and health characteristics have intertwined in small rural communities over the period 1980 to 2010. We focus on places with fewer than 2,500 residents but contrast their conditions and patterns of change with slightly larger places (2,500-19,999 pop.) to improve understanding of unique place-based challenges. We create a place-based dataset by integrating data from the Census Bureau, National Center for Health Statistics, USDA, FCC, National Park Service and other sources. Importantly, methodological innovations are undertaken to generate a place-based health information, an important extension since health data tends to be available only at the county level. In the end, we argue that the small size and isolation of tiny towns pose particular challenges for policies and programs designed to improve public health, economic opportunity and social well-being. Improved understanding of their socioeconomic, demographic and health dynamics is critically essential for the development of informed policy.